Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.</p> <p>Methods</p> <p>The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25^thgestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.</p> <p>Results</p> <p>Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10^thcentile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example.</p> <p>There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.</p> <p>Conclusion</p> <p>Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.</p

Evaluation of translocation as a tool for mitigating development threats to great crested newts (Triturus cristatus) in England, 1990-2001

Great crested newts (Triturus cristatus) are protected under European and UK legislation, but are frequently the subject of conflict between development and conservation in England. When this occurs, the developer is legally obliged to instigate a mitigation plan to reduce the impacts on the newts. This usually involves the translocation of newts coupled with habitat enhancement and creation. We reviewed mitigation projects carried out in England between 1990 and 2001 by (1) analysing licensing information collected by the governmental licensing authorities; and (2) a questionnaire survey of a sample of mitigation projects. Over half of the licensed projects on file contained no report of the work undertaken. There was an increase in the number of new translocation projects from less than 10 a year in the early 1990s to over 80 a year by 2000. This translates into about 1.5 million per year currently being spent on grew: crested newt mitigation projects. Most of these projects involved in situ translocations of newts to areas within or adjacent to the development site. The number of newts translocated per project declined over the same period, and was related to the total area of habitat destroyed and work effort. About 27% of great crested newt terrestrial habitat was destroyed during the developments along with about half of all ponds. Although the number of new ponds created compensated for the number of known great crested newt ponds lost, there was a net loss in terms of overall area of aquatic habitat. Where follow-up monitoring of translocations was conducted, there was evidence of breeding at most sites one-year post-development, but it is unclear whether these populations were sustainable in the long-term. (C) 2004 Elsevier Ltd. All rights reserved

Waste not, want not: the sustainability of medieval manuscripts

Manuscript books – as the material incarnations of medieval literature – present intriguing avenues of inquiry into the nature of literature and sustainability. This discussion is structured to address the animal origins of the manuscript, and then to move from the heart of the physical book outwards, from examples of reinforcing strips, via other parchment reuses, finishing with wrappers. Manuscript case studies of each of these phenomena are drawn from medieval collections held in Oxford, Cambridge and Worcester Cathedral. This article debates concepts of “sustainability”, reading two senses of sustainability in the production and treatment of books in the fifteenth century. Throughout this discussion, manuscript books are found to exist in a “dynamic ecology of use and reuse”. Therefore, the evidence considered in this article suggests that books and book materials were indeed subject to widespread “waste not, want not” attitudes